United States District Court, S.D. New York
October 12, 2005.
ARTHUR REID, Plaintiff,
AETNA LIFE INSURANCE CO., Defendants.
The opinion of the court was delivered by: COLLEEN McMAHON, District Judge
DECISION AND ORDER GRANTING DEFENDANT'S MOTION FOR SUMMARY
JUDGMENT AND DENYING PLAINTIFF'S CROSS-MOTION
Plaintiff, a computer programmer analyst at a computer
consulting firm, became unable to work and went on long-term
disability in February 2000, after complaining of chest pains and
blackouts brought on by work-related stress. Plaintiff was
subsequently diagnosed with arterial clogging in his chest and
legs and spinal compression, leading to pain symptoms in his
knees, legs, and lower back. At the same time, Plaintiff
underwent treatment for depression, memory loss and lowered
cognitive functions, and symptoms of rage and anger.
The terms of the Plaintiff's long-term disability insurance
plan stated that benefits for disability caused "to any extent"
by mental or nervous causes would be terminated after twenty-four
months. Defendant, pursuant to that plan, terminated benefits in
February, 2002. Plaintiff sought and received a reconsideration
of the termination; a final decision upholding termination was made in May 2002.
Plaintiff brought suit under 29 U.S.C. § 1132, which enables
civil actions for the enforcement of rights under an employee
benefit plan covered by the Employee Retirement Income Security
Act (ERISA). Upon submission of the administrative record and
affidavits by both sides, Defendant moved for summary judgment.
Plaintiff opposed and cross-moved for summary judgment as well.
For the reasons stated below, the Defendant's motion is GRANTED
and Plaintiff's cross-motion is DENIED.
Plaintiff was employed as a computer programmer analyst and
project manager at GRC International, a Virginia-based
corporation which provides technical consulting services to the
Department of Defense and other government agencies. AReid01313.
Prior to his employment at GRC in February, 1997, Plaintiff had
twenty-two years of experience as a programmer at IBM.
Plaintiff's Opposition to Defendant's Motion for Summary Judgment
and In Support of Cross-Motion for Summary Judgment
(hereinafter, "Opposition") at 2. His work as a programmer
analyst at GRC was described as 95% sedentary, with no lifting or
pulling, and no exposure to dangerous materials. AReid01310.
Prior to 1997, Plaintiff was relatively athletic and active,
engaging in running, recreational basketball, and other
activities. Areid00253. At the same time, he smoked two or more
packs of cigarettes a day, had not had a physical examination in
fifteen years, and appeared obese. Id. Through GRC, Plaintiff was covered by a Group Life and Accident
and Health Insurance Policy ("the Plan"), which included
long-term disability coverage, provided by Aetna Life Insurance
Co. (hereinafter, "Defendant"). See Affidavit of Maria
Piotrowski (hereinafter, "Affidavit") at ¶ 2 . The Plan is an
"employee benefit plan" under the terms of the Employee
Retirement Income Security Act (ERISA). 29 U.S.C. § 1101(a)
(2000). Disability for purposes of the Plan is defined as an
incapacity, "solely because of injury or disease, to perform the
material duties of your own occupation" for 36 months after the
time of injury. Areid01641. After thirty-six months, a claimant
must be shown to be unable to work in any reasonable
occupation, solely due to illness or disease, to continue
receiving benefits. Id. AReid01634,01642. However, long-term
disability benefits could be terminated after twenty-four months
if the disability is at that time caused to any extent by a
mental condition.*fn1 AReid01642-01643.
The Plaintiff's medical history, largely undisputed, is as
follows. In May 1997, Plaintiff first complained of pain in both
legs brought on by extensive walking or playing basketball.
Areid00262. This pain did not limit his range of joint motion.
Id. He was referred to Dr. Louise Reynolds of Vienna Family
Medicine, who diagnosed him as having claudication a reduced
flow of blood to the legs caused by arterial clogging. The
patient attempted chelation treatment ingestion of the chemical
EDTA to increase blood flow without surgery.*fn2 Areid00253.
In addition, he was diagnosed with high cholesterol and
non-insulin dependent diabetes mellitus, which he sought to control with prescription medications. Id.
Furthermore, Dr. Reynolds issued the Plaintiff a prescription for
a nicotine patch to control his cigarette addiction. Id.
Initially, the Plaintiff did not fully cooperate with his
medication regimen. Areid002490-0252. He did not begin to use the
patch, "intermittently" took medication for cholesterol, and
possibly ceased taking the prescribed diabetes medication.
Areid00248. By late 1998, although the initial symptoms of leg
pain had decreased, he reported new pain in the ball of his left
foot. AReid00245. He treated the pain with prescription
ibuprofen. Areid00242. In mid-1999, the symptoms of foot pain
apparently re-appeared, and were re-treated with ibuprofen by a
Dr. Cecil. Areid00242 There is no record of the Plaintiff's
raising his prior issues of high cholesterol or diabetes at this
In late 1999, Plaintiff, now a GRC project manager, was asked
to terminate two individuals under his employ as a cost-cutting
measure, a request which apparently caused him a significant
amount of stress and confusion. Areid00889. In October, he began
to suffer from chest pains, burning sensations in his left arm,
and numbness. AReid00240. On November 8, 1999, after Plaintiff
had fired one employee, GRC notified him that he would also be
let go. Areid00889. That event triggered increased chest pain and
an intense blackout; he was admitted to the emergency room at
Fairfax Inova Hospital complaining of chest pain, numbness, and
tenderness in the rib cage. Areid00379. A thallium scan detected
possible inferior ischemia reduced blood flow to the heart.
Id. Further analysis based on a November 11th
catheterization probe of his chest detected significant plaque in
the left coronary system, and a possible lesion in the right
coronary artery. Areid01236. The Plaintiff opted in favor of
non-invasive treatment rather than an angioplasty at this time.
Areid01237. As a result of his hospitalization, Plaintiff came under the
care of Dr. Kerry Prewitt for care of the pain in his legs. His
initial report notes that Plaintiff was still unable to walk more
than one or two blocks before onset of pain. Areid00075. On
January 14 and 21, 2000, successive femoral angioplasties were
performed on the Plaintiff's right and left legs to address the
reduced blood flow. Areid00114. The therapeutic effect of the
angioplasties was limited Plaintiff returned with complaints of
pain in his legs and left foot almost immediately afterwards.
Areid00112. Dr. Prewitt, at that time, concluded that the new
symptoms were not the product of claudication. Id.
Plaintiff subsequently sought treatment from Dr. Bruce Smith,
who evaluated the Plaintiff and diagnosed a herniated disk in his
back and compression of the spine. Areid00154. This finding was
confirmed by a September 18, 2000, MRI, which detected disk
herniation and mild stenosis painful pressure on the spinal
nerves by vertebrae. Areid00160. Dr. Smith also noted how
Plaintiff's ongoing depression constituted a risk factor and
could affect his ability to interact with physicians. Areid00154.
At this point, Plaintiff agreed to wait before moving to
consultation with an orthopedic surgeon. Id.
In a June 2000 letter, Dr. Prewitt indicated that the
Plaintiff's leg pain had spread, and now occurred while Plaintiff
was immobile. Areid00162. He also noted Plaintiff's unease with
the length of time the visit required, difficulty in remembering
drug dosages and prior diagnoses, and interest in chelation
therapy rather than repeated angiograms or angioplasties. Id.
By August, 2000, Plaintiff had come under the care of Dr. James
Melisi, a neurosurgeon. Dr. Melisi's complete file is not
included in the record provided. Opposition at 7. It appears,
however, that in May 2001, Dr. Melisi scheduled Plaintiff for a
laminectomy surgery on the vertebrae to remove pressure on the spinal nerves. Areid00063.
This operation was aborted after a pre-operative screening
detected Plaintiff's blood sugar level at over 600. Id. A
pre-operative report, dated May 7, 2000, by Dr. Harvey Sherber,
notes normal electrocardiogram results and some walking ability.
AReid00055-00058. Dr. Sherber also noted concern for Plaintiff's
long-term cardiovascular health. The laminectomy was successfully
performed two months later, and post-operative MRIs indicated a
clean prognosis and no need for additional spinal surgery.
Beginning in April 2001, Plaintiff complained of new pain in
his knee joints. He was referred to Dr. Christopher Annunziato,
who treated him with lidocaine injections in late April, 2001.
Areid00743. When these injections did not arrest the Plaintiff's
symptoms, he opted to undergo arthroscopic surgery on his right
knee on August 20, 2001. Areid00738. Similar surgery was planned
for the left knee, although never completed. Opposition at 9.
The arthroscopic surgery apparently had minimal impact on the
Plaintiff's pain symptoms. In his last patient report, Dr.
Annunziata observed continued pain, although also noted a range
of knee movement of up to 120 degrees. Areid00734. Plaintiff
entered physical therapy at Phyllis Moriarty & Associates in
January, 2002. His initial consultation showed intense lower back
and rear pain, limited leaning ability, and difficulty sleeping
on his back. Areid00674. Although it is not clear how long he
attended physical therapy, records indicate approximately a month
of constant attendance. Areid00677-00678. He subsequently began
treatment with Dr. Michael Vierio, a chiropractor, on February
11, 2002. Opposition at 10. His records are not included in the
file, although he submitted a note, stating the plaintiff was
totally disabled due to back pain, to the claims administrator.*fn3
In December 1999, after his initial hospitalization at Fairfax
Inova, Plaintiff began to see Dr. Diane Milliken and Dr. Vell
Rives mental health providers at the North Virginia Psychiatric
Group ("Nova") for psychological evaluation and treatment. He
was diagnosed with anger management and stress-related issues;
symptoms of sleeplessness, memory loss and social uneasiness were
noted. Areid00215-00220. He began taking Zoloft and Zyprexa for
his psychological symptoms. Id. Although the initial report
indicated only a 6-visit course of treatment, Id., he continued
to see Dr. Rives for almost two years in total.
After his initial visits in 1999, Plaintiff began to develop
new psychological difficulties. He reported increased depression,
feelings of rage, and fear of being watched by large
conspiracies. Areid00200-00203. The Plaintiff's statements
indicated a fixation on work and the events of his firing, with
alternating feelings of guilt, anger, and fear as a result. Id.
Depression, anxiety, paranoia, and sleep disorders continued
through 2000, with some improvement noted by September, 2000.
Areid00192-00187. Plaintiff's mood at that point appeared to
brighten, with less job-related obsession. Id. In September
2000, Dr. Rives completed a Mental Health Provider's Statement in
September 2000, which noted no restrictions on Plaintiff,
although he noted limited interpersonal skills with others and
recommended that the Plaintiff not resume work until January,
2001. Areid00213. These observations were supported by the report of Claims
Consultant Ron Hartleib, who interviewed Plaintiff in February,
2000, and noted that the Plaintiff was staying at home in the
dark with the curtains drawn, and had difficulty remembering
events and understanding questions. Areid01302-01306. A separate
report by Dr. Harry DeVanney for the Virginia Department of
Rehabilitative Services, performed on May 31, 2000, noted severe
dysthymia (mild, long-term depression), generalized anxiety
disorder with chest pain, impaired visual and verbal memories,
and possible mild physical damage to the brain. Areid00889-00892.
The Plaintiff's post-1999 patient records from Nova are not in
the administrative file. The next relevant document consists of a
Mental Health Provider's Statement, dated November, 6, 2001 from
Dr. Renee Payne, who apparently replaced Dr. Rives as Plaintiff's
primary mental health provider. Dr. Payne's report deviates
significantly from Dr. Rives' 2000 report. She found Plaintiff to
be totally disabled, and noted a complete inability to perform
almost any work-related task. Areid00032-00033. She further notes
that Plaintiff was non-compliant in his treatment regimen, and
suffered from anxiety, depressed mood, and "persecutory
delusions." Id. She notes that she had been seeing Plaintiff
every few months, but no description of the meetings, or reason
for the decline in Plaintiff's well-being from the previous year,
is provided. Id.
In April, 2000, Plaintiff was found to be eligible for
long-term disability benefits, retroactive to February, 2000.
Areid00335-00336. A letter dated April 19, 2000 confirmed this
fact but did not provide any underlying medical reason. Id. It
also stated that Plaintiff was subject to periodic re-evaluation concerning his condition and
continued disability. Id. Defendant apparently reviewed
claimant medical history through "Attending Physician Statements"
("APSs"), completed by a claimant's treating physicians, and
Mental Health Provider's Statements, completed by treating
psychiatrists. Areid00008. The Defendant required claimants to
distribute these forms to their health care professionals and
solicit responses. Id. Defendant could also require an
independent physical examination, although it argues claimants do
not have a right to such an exam. See Areid00537.
On April 10, 2001, Defendant conducted a review of the file,
and found Plaintiff disabled, subject to the mental/nervous
policy limitation. Areid00066. At that time, investigators
considered whether the Plaintiff's heart condition was a separate
cause of total disability, which would have avoided the 24-month
cap. Id. However, further investigation found that the
condition was not disabling. Id. Defendant contacted the
Plaintiff and alerted him to the possibility that his long-term
disability benefits might be subject to the twenty-four month
mental/nervous limitation. Areid00053. Plaintiff challenged this
finding, apparently in the belief that the restriction applied to
disabilities that were only mental in nature. Areid00052.
In late 2001, Defendant recommenced an investigation of
Plaintiff's case, and in the process solicited statements from
all Plaintiff's doctors and mental health providers. Areid00030.
Reports were filed by Drs. Payne, Reynolds, Annunziata, and
Melisi; all filed at least two separate reports or letters to
Defendant between November and January. Affidavit ¶¶ 26-32. After
considering these reports, Defendant decided to terminate
benefits in February, 2002, after twenty-four months, on the
grounds that Plaintiff's disability was caused in part by mental
reasons. Id. ¶ 33. A letter communicating that fact was sent on
February 4, 2002. Id., Areid00658 Plaintiff appealed this determination by letter on February 28,
including with his letter two MRI reports related to his back, a
Physical Therapy Status Report from Phyllis Moriarty and
Associates, and a note from Dr. Michael Vierio, a Chiropractor,
dated March 1, 2002 [sic]. Id. at ¶ 35. Plaintiff also had his
more recent medical records, such as Dr. Annunziata's file, faxed
to the Defendant as well. Areid00733-00746. Plaintiff also
requested an independent physical examination, but was informed
that such an examination was at the discretion of the Defendant
only. Affidavit at ¶ 43. His file, including the newly submitted
material, was reviewed by Dr. Joseph L. Braun, Defendant's
Medical Consultant, and Maria Piotrowski, an Appeals Analyst, and
the decision to terminate was re-affirmed in May. Id. at ¶¶ 1,
38. Subsequent appeals by the Plaintiff with further medical
documentation, largely from new doctors, were unavailing.
Plaintiff subsequently complained to both the State of New York
Insurance Department, Areid00440-00441, and the Virginia
Department of Insurance Complaints. Areid00433. New York seems to
have rejected Plaintiff's claim in October, 2002. Areid00969.
Thereafter, Plaintiff brought suit against GRC and Aetna under
the Employee Retirement Income Security Act (ERISA) on November
1, 2004. Complaint at ¶ 24. Plaintiff's claims against GRC have
since been withdrawn, leaving Aetna as the remaining defendant.
ERISA provides a federal cause of action for an ERISA-covered
insurance plan participant or beneficiary, "to recover benefits
due to him under the terms of his plan, to enforce his rights
under the terms of the plan, or to clarify his rights to future
benefits under the terms of the plan." 28 U.S.C. § 1132 (2000). "A denial of benefits
challenged under [ERISA] must be reviewed under a de novo
standard unless the benefit plan gives the administrator or
fiduciary discretionary authority to determine eligibility for
benefits or construe the terms of the plan." Firestone Tire &
Rubber Co. v. Bruch, 489 U.S. 101, 115, 10 S. Ct. 948, 956-57,
103 L. Ed. 2d 80, (1989). The parties have agreed that the plan
in question does not confer discretionary authority on Aetna, the
claim fiduciary, to interpret its terms. Therefore, the
determination of the administrator terminating Mr. Reid's
benefits at the 24-month point is reviewed de novo.
Determination to Expand the Record
In the Second Circuit, de novo review of an ERISA claim
determination "is limited to the record in front of the claims
administrator unless the District Court finds good cause to
consider additional evidence." DeFelice v. Am. Int'l Life
Assurance Co. of N.Y., 112 F.3d 61, 67 (2d Cir. 1997). This
good-cause requirement is not a per se rule permitting expansion
of the record whenever a plan administrator or fiduciary acts as
a claim examiner. See Locher v. Unum Life Ins. Co. of Am.,
389 F.3d 288, 296-297 (2d Cir. 2004). Rather, the claims
procedure must be shown to be flawed or arbitrary. See id.
The Second Circuit has not indicated a single test that
determines the reliability of a claim procedure; however, lack of
notice to the claimant as to the basis for an initial rejection,
or denial of the claimant's right to submit new information in
light of an initial rejection are significant factors in the
analysis. See Juliano v. Health Maint. Org. of N.J.,
221 F.3d 279, 289 (2d Cir. 2000); cf. Muller v. First Unum Life Ins.
Co., 341 F.3d 119, 125-126 (2d Cir. 2003) (finding process
granting claimant, "ample time to submit additional materials"
and involving some communication with one doctor sufficient to
deny expansion of the record). Furthermore, the court may not consider materials
that arose after the time that the record was closed, absent a
showing of bad faith or a conflict of interest. See id.; see
also Salute v. Aetna Life Ins. Co., 2005 WL 1962254 at *6
(E.D.N.Y. Aug. 9, 2005).
Plaintiff has noted numerous gaps and absences in the
administrative record that, he argues, call for a denial of
summary judgment and an expansion of the factual record. Most
significant is the absence of the records of Dr. Melisi, Inova
Fairfax Hospital's records of Plaintiff's laminectomy, and the
record of Plaintiff's post-laminectomy physical therapy.*fn4
Opposition at 22-23. Plaintiff further argues that he made the
names of these professionals known to Defendant during its
review, and provided releases such that the burden of acquiring
the records fell on the investigator. Id. at 23.
The absence of such material does make the record of
Plaintiff's treatment, especially in the second year of his
disability, somewhat opaque. I note, however, that Plaintiff
successfully sought and received the records of Dr. Annunziata,
Phyllis Moriarty and Associates, and Dr. Payne's Mental Health
Provider's Statement, on or around February 7, 2002, after the
initial termination of benefits. Areid00724-00783, see also
Areid00666 (discussing communications between Plaintiff,
Plaintiff's doctors and Defendant in early February). Plaintiff
continued to submit medical information throughout 2002. Since
Plaintiff had sufficient time and knowledge to find and acquire
these records, it is not clear why these other records, if
relevant, could not have been acquired in the same manner.
Furthermore, the records provided by the Plaintiff after the
initial termination, taken with existing APSs and prior records
already in Defendant's possession, were hardly an inadequate basis for a reconsidered
ruling. Therefore, mere absence of these records does not show
that the claim procedure was flawed.
Plaintiff has also sought the inclusion of the records of Dr.
Vierio, Dr. Nejad, and Dr. Alan Mogliner, materials apparently
generated after the denial of benefits in February, 2002.
Opposition at 23. As the Plaintiff himself notes, however, the
relevant time period for consideration of a claimant's medical
history is twenty-four months after the initial receipt of
benefits. Id. at 14; see also Areid01642. Medical
documentation generated after that time, especially documentation
based on immediately present symptoms such as pain or lack of
mobility, has nothing to do with whether Plaintiff's disability
as of February 2002 was caused in part by psychological factors.
Therefore, inclusion of such information from the factual record
before the court would not assist this Court in its de novo
Plaintiff has also sought to add records about the
investigation of Dr. Braun, Defendant's in-house claims reviewer.
Opposition at 23. Dr. Braun, however, did not examine the
Plaintiff at any time. He simply reviewed the administrative
record and assisted in making a claims determination based on its
contents. There is no reason to expand the record to include the
inclusion of Dr. Braun's notes, if any exist.
Plaintiff submits that the disagreement between Dr. Braun's
diagnosis and the prior diagnosis of Dr. Michael Mittelmann, also
in the employ of Defendant, requires denial of summary judgment.
Opposition at 18. However, these analyses were performed almost a
year apart, and were based on different standards. Prior to the
end of the twenty-four month period, the only relevant question
for Dr. Mittelmann was whether the claimant was disabled for any
reason. Dr. Braun undertook his review at a time when the issue
was whether Plaintiff's disability was caused to any extent by mental or nervous
conditions. Therefore, any difference in the two physician's
conclusions is irrelevant.
Defendant's Motion for Summary Judgment
Under Rule 56(c) of the Federal Rules of Civil Procedure, the
Court will grant summary judgment if the evidence offered shows
that there is no genuine issue as to any material fact and that
the movant is entitled to judgment as a matter of law. See
Celotex Corp. v. Catrett, 477 U.S. 317, 106 S. Ct. 2548,
91 L. Ed. 2d 265 (1986). The Court views the record in the light most
favorable to the non-movant and resolves all ambiguities and
draws all reasonable inferences against the movant. See United
States v. Diebold, Inc., 369 U.S. 654, 655, 82 S. Ct. 993, 994,
8 L. Ed. 2d 176 (1962); Donahue v. Windsor Locks Bd. of Fire
Commn'rs, 834 F.2d 54, 57 (2d Cir. 1987).
This standard is applied in light of the relevant language of
the Plan. This language states that:
a period of total disability will end after 24
monthly benefits are payable if it is determined that
the disability is, at that time, caused to any
extent by a mental condition . . . described in the
most current edition of the Diagnostic and
Statistical Manual of Mental Disorders.
Areid01642 (emphasis added).
Plaintiff argues that this language requires that a mental
condition must itself be independently disabling at the time in
question a somewhat strange argument considering that such a
conclusion is wholly supported by Dr. Payne's report. Opposition
at 14. Defendant contends that the Plan cuts off benefits for "a
claim caused even to a relatively modest degree by a mental condition." Defendant's Memorandum of Law in Opposition
to Plaintiff's Cross-Motion for Summary Judgment, at 10.
Defendant is correct. As long as mental health issues contributed
in some way to Plaintiff's inability to work, Defendant was
within its rights in cutting off benefits.
In this case, there is no question that Plaintiff's mental
impairments at the very least contributed to Plaintiff's
inability to work as of February 2002. Plaintiff's own mental
health doctor, Dr. Renee Payne, noted in her November 2001 Mental
Health Provider's Statement that the plaintiff was "markedly
limited" or "unable to perform" all work-related activities,
including performing simple or complex tasks, following
instructions, or interacting with others. Areid00032-00033. This
determination seems to have been based solely on psychological
Plaintiff's health records from 1997 onwards do reveal that
Plaintiff has had at least three separate strains of possibly
debilitating physical ailments: (1) pain in his legs, lower back,
knees, and feet, which were treated between 2000 and 2002 with
angioplasties in both legs, arthroscopic surgery in one knee, and
spinal laminectomy; (2) diabetes, which was treated with various
medications beginning in 1997; and (3) chest pains or
heart-related ailments, which appeared in late 1999,
contemporaneously with his work-related stress. His most recent
APSs and 2001 medical records indicate that the leg, foot and
lower back pain constituted the most significant ailment prior to
the twenty-four month cutoff.
There is no issue that Plaintiff suffered from multiple
physical problems. However, the administrative record does not
support a finding that Plaintiff's mental health issues did not
contribute to his disability. First, the Attending Physician Statements submitted in late
2001 by the Plaintiff's primary physicians Drs. Melisi,
Annunziata, and Reynolds do not indicate that Plaintiff's pain
or other physical conditions were independently disabling.
Areid00003-00004, 00010-00011, 00039-00040. Dr. Melisi's & Dr.
Reynolds' reports indicate that Plaintiff is "capable of
clerical/administrative (sedentary) activity", and indicates only
limitations on Plaintiff's lifting capability; Dr. Annunziata's
report indicates "no limitation" on Plaintiff at all. Id.
Available medical records from late 2001 and early 2002,
including the records of Dr. Annunziata and Phyllis Moriarty &
Associates, the Plaintiff's own physical therapists, indicate
that the Plaintiff had continued strength and range of motion in
the afflicted joints and was capable of performing seated work,
despite ongoing pain. Areid00733-00734, Areid007470-0755.
Dr. Reynolds provided a second APS on February 7, 2002, in
which she re-diagnoses Plaintiff as "incapable of sedentary
activity," noting "he is in pain all the time and can barely
ambulate," and "anxiety and chest pain brought on by stressful
conditions are incapacitating for him." Areid00724-00728. She
defines "stressful conditions" as "interactions with his
superiors at work." Id. This report states that the Plaintiff
is newly disabled, but attributes his decline to stress as much
as to an increase in pain symptoms.
For another, the Plaintiff's depression, although perhaps not
the root cause of his pain symptoms, chest pain, or diabetes,
contributed to the Plaintiff's apparent inability to take
medication regularly or remain on a course of treatment.
Depression was noted as a complicating factor in the Plaintiff's
treatment in September 2000. Areid00154 ("I have discussed with
him how [his depression] might impact both his symptoms and his
interactions with physicians."). disability.
As this Court recently held, attempts to reclassify a
disability as physical in order to avoid a twenty-four month
limitation should be closely scrutinized. See Bergquist v.
Aetna U.S. Healthcare, 289 F. Supp. 2d 400, 412 (S.D.N.Y. 2003)
(McMahon, J.). In this case, Plaintiff's prior submissions to
Defendant, including his own request for reconsideration in
February 2002, indicate that his inability to work was not solely
physical. E.g., Areid00612-00614. Nothing in the record before
me supports a conclusion that the Plaintiff's psychological
issues, which contributed to the Plaintiff's disability in 2000
and 2001, ceased to be disabling in February, 2002. Since the
Plan cut off benefits if the disability is caused even in part
by mental factors, Plaintiff's claim for benefits must be denied.
For the reasons discussed above, I grant the motion of
Defendant Aetna Life Insurance Co. for summary judgment and deny
the motion of Plaintiff Arthur Reid for summary judgment. The
Clerk of the Court is directed to enter judgment for defendant,
and to close the file.
This constitutes the decision and order of the Court.
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